title: Dyssynchronous ventricular contraction in Wolff-Parkinson-White syndrome: a risk factor for the development of dilated cardiomyopathy.
abstract: Emerging evidence suggests that significant left ventricular dysfunction may arise in right-sided septal or paraseptal accessory pathways (APs) with Wolff-Parkinson-White syndrome, even in the absence of recurrent or incessant tachycardia. During 1 year and 9 months, we identified four consecutive female children with median age of 8 years diagnosed as having dilated cardiomyopathy (DCM) combined with overt right-sided APs several years ago. Incessant or recurrent tachycardia as the cause of DCM could be excluded. Anti-heart failure chemotherapy did not produce satisfactory effects. The patients underwent radiofrequency ablations (RFCAs). This report describes the clinical and echocardiographic characteristics of the cases before and after the ablation. Dyssynchronous ventricular contraction was observed in all patients. The locations of the APs were the right-sided anteroseptum and the free wall (n = 2 each). All patients received successful RFCAs. Their physical activities and growth improved greatly, and the echocardiographic data demonstrated that their left ventricular (LV) contraction recovered to synchrony shortly after the ablation and that their LV function recovered to normal gradually during the follow-up.
  
  
  CONCLUSIONS
  A causal relationship between overt ventricular preexcitation and the development of DCM is supported by the complete recovery of LV function and reversed LV remodeling after the loss of ventricular preexcitation. Preexcitation-related dyssynchrony was probably the crucial mechanism. Not only right-sided septal or paraseptal but also free wall overt APs may induce LV dysfunction and even DCM. AP-induced DCM is an indication for ablation with a good prognosis.
authors.affiliation: Department of Pediatric Cardiology, Capital Medical University, Beijing Anzhen Hospital, Beijing, China.
authors.forename: Chen-Cheng
authors.initials: CC
authors.lastname: Dai
authors.forename: Bao-Jing
authors.initials: BJ
authors.lastname: Guo
authors.forename: Wen-Xiu
authors.initials: WX
authors.lastname: Li
authors.forename: Yan-Yan
authors.initials: YY
authors.lastname: Xiao
authors.forename: Mei
authors.initials: M
authors.lastname: Jin
authors.forename: Lin
authors.initials: L
authors.lastname: Han
authors.forename: Jing-Ping
authors.initials: JP
authors.lastname: Sun
authors.forename: Cheuk-Man
authors.initials: CM
authors.lastname: Yu
authors.forename: Jian-Zeng
authors.initials: JZ
authors.lastname: Dong
mesh_terms: D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D017115:Catheter Ablation; D002648:Child; D004562:Electrocardiography; D005260:Female; D006801:Humans; D012307:Risk Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D014927:Wolff-Parkinson-White Syndrome / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery